DOI: https://doi.org/10.18370/2309-4117.2019.47.35-42

Modern approaches to diagnostics of hyperandrogenism distributed forms in reproductive aged women

О. А. Бурка, М. І. Бобрик, В. М. Резниченко, Т. М. Тутченко

Abstract


PCOS is a widespread endocrine disorder of polymorphic ethiology and pathogenesis and varying phenotypic forms that has negative effect non only on reproductive function but also on glucose and lipid metabolism, cardiovascular health, psychological wellbeing and oncologic risks throughout all life of women and their offsprings.

Diagnosis of PCOS is based upon at least 2 of the 3 criteria: clinical/biochemical hyperandrogenism, olygo-anovulation, polycystic ovarian morphotype on ultrasound. Exclusion of all other causes of hyperandogenism and anovulation is mandatory.

PCOS women both with and without obesity or overweight have significantly higher risk of glucose metabolism disorders and dyslipidemia starting from reproductive age, which leads to diabetes mellitus and cardiovascular disease in older age.

Interconnected processes of hyperandrogenism and insulin resistance are the main causes of high risks of cardiometabolic complications in women with PCOS.

At the same time PCOS is among risk factors of DM2 which makes screening of all women with PCOS for disglycemia irrespectable of BMI reasonable.

Evaluation of insulin resistance in PCOS in clinical setting may be complicated.

Contemporary laboratory tests make diagnosis of all stages of dysglicemia from insulin resistance to diabetes possible as well as monitoring of applied interventions (lifestyle modification, medications).

Thus, contemporary management of PCOS implies not only correction of reproductive disorders but also prevention of metabolic risks and comorbidities lifelong starting from the moment PCOS is diagnosed.


Keywords


insulin resistance; abdominal obesity; impaired glucose tolerance; hyperglycemia; proinsulin; hyperandrogenism

References


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GOST Style Citations


1.         Rocha, A.L., Oliveira, F.R., Azevedo, R.C., et al. “Recent advances in the understanding and management of polycystic ovary syndrome. F1000Research 8 (2019): 565.

2.         Fauser, B.C.J.M., Tarlatzis, B.C., Rebar, R.W., et al. “Consensus on women’s health aspects of polycystic ovary syndrome

(PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.” Fertil Steril 97.1 (2012): 28–38.e25.

3.         Kakoly, N.S., Khomami, M.B., Joham, A.E., et al. “Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression.” Hum Reprod Update 24.4 (2018): 455–67.

4.         Wild, R.A., Rizzo, M., Clifton, S., Carmina, E. “Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis.” Fertil Steril 95.3 (2011): 1073–1079.e11.

5.         Schmidt, J., Landin-Wilhelmsen, K., Brännström, M., Dahlgren, E. “Cardiovascular Disease and Risk Factors in PCOS Women of Postmenopausal Age: A 21-Year Controlled Follow-Up Study.” J Clin Endocrinol Metab 96.12 (2011): 3794–803.

6.         Behboudi-Gandevani, S., Ramezani Tehrani, F., Hosseinpanah, F., et al. “Cardiometabolic risks in polycystic ovary syndrome: long-term population-based follow-up study.” Fertil Steril 110.7 (2018): 1377–86.

7.         Yu, H.-F., Chen, H.-S., Rao, D.-P., Gong, J. “Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis.” Medicine (Baltimore) 95.51 (2016): e4863.

8.         Kahal, H., Kyrou, I., Tahrani, A.A., Randeva, H.S. “Obstructive sleep apnoea and polycystic ovary syndrome: A comprehensive review of clinical interactions and underlying pathophysiology.” Clin Endocrinol (Oxf) 87.4 (2017): 313–9.

9.         Cooney, L.G., Lee, I., Sammel, M.D., Dokras, A. “High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis.” Hum Reprod 32.5 (2017): 1075–91.

10.       Barry, J., Azizia, M. “Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis.” Update PH-H reproduction (2014). Available from: [https://academic. oup.com/humupd/article-abstract/20/5/748/2952619], last accessed May 16, 2019.

11.       Rocha, A.L.L., Faria, L.C., Guimarães, T.C.M., et al. “Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis.” J Endocrinol Invest 40.12 (2017): 1279–88.

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13.       Romitti, M., Fabris, V.C., Ziegelmann, P.K., et al. “Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis.” Endocr Connect 7.11 (2018): 1158–67.

14.       Shi, X.-Y., Huang, A.-P., Xie, D.-W., Yu, X.-L. “Association of vitamin D receptor gene variants with polycystic ovary syndrome: a meta-analysis.” BMC Med Genet 20.1 (2019): 32.

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16.       American Diabetes Association. “Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers.” Clin Diabetes 36.1 (2018): 14–37.

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22.       Cassar, S., Misso, M.L., Hopkins, W.G., et al. “Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies.” Hum Reprod 31.11 (2016): 2619–31.

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26.       Samuel, V.T., Shulman, G.I. “The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux.” J Clin Invest 126.1 (2016): 12–22.

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31.       Meyer, C., McGrath, B.P., Cameron, J., et al. “Vascular Dysfunction and Metabolic Parameters in Polycystic Ovary Syndrome.” J Clin Endocrinol Metab 90.8 (2005): 4630–5.

32.       Zimmermann, S., Phillips, R.A., Dunaif, A., et al. “Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance.” J Clin Endocrinol Metab 75.2 (1992): 508–13.

33.       Elting, M.W., Korsen, T.J., Bezemer, P.D., Schoemaker, J. “Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population.” Hum Reprod 16.3 (2001): 556–60.

34.       Chen, M.-J., Yang, W.-S., Yang, J.-H., et al. “Relationship Between Androgen Levels and Blood Pressure in Young Women With Polycystic Ovary Syndrome.” Hypertension 49.6 (2007): 1442–7.

35.       Holte, J., Gennarelli, G., Berne, C., et al. “Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state?” Hum Reprod 11.1 (1996): 23–8.

36.       Moretti, C., Lanzolla, G., Moretti, M., et al. “Androgens and Hypertension in Men and Women: a Unifying View.” Curr Hypertens Rep 19.5 (2017): 44.

37.       Wenner, M.M., Taylor, H.S., Stachenfeld, N.S. “Androgens influence microvascular dilation in PCOS through ET-A and ET-B receptors.” Am J Physiol Metab 305.7 (2013): E818–25.

38.       Wenner, M.M., Taylor, H.S., Stachenfeld, N.S. “Endothelin B receptor contribution to peripheral microvascular function in women with polycystic ovary syndrome.” J Physiol. 589 Pt 19 (2011): 4671–9.

39.       Gilbert, E.W., Tay, C.T., Hiam, D.S., et al. “Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews.” Clin Endocrinol (Oxf) 89.6 (2018): 683–99.

40.       Khatibi, A., Agardh, C.-D., Shakir, Y.A., et al. “Could androgens protect middle-aged women from cardiovascular events? A population-based study of Swedish women: The Women’s Health in the Lund Area (WHILA) Study.” Climacteric 10.5 (2007): 386–92.

41.       Berridge, M.J. “Vitamin D cell signalling in health and disease.” Biochem Biophys Res Commun 460.1 (2015): 53–71. https://www.sciencedirect.com/science/article/pii/S0006291X15000297

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43.       Komisarenko, Y.I., Bobryk, M.I. “Vitamin D Deficiency and Immune Disorders in Combined Endocrine Pathology.” Front Endocrinol (Lausanne) 9 (2018): 600.

44.       Wehr, E., Pilz, S., Schweighofer, N., et al. “Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome.” Eur J Endocrinol 161.4 (2009): 575–82.

45.       Hassan, N.E., El-Orabi, H.A., Eid, Y.M., Mohammed, N.R. “Effect of 25-hydroxyvitamin D on metabolic parameters and insulin resistance in patients with polycystic ovarian syndrome.” Middle East Fertil Soc J 17.3 (2012): 176–80.

46.       Kim, J.J., Choi, Y.M., Chae, S.J., et al. “Vitamin D deficiency in women with polycystic ovary syndrome.” Clin Exp Reprod Med 41(2) (2014): 80–5.

47.       Li, H.W.R., Brereton, R.E., Anderson, R.A., et al. “Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome.” Metabolism 60.10 (2011): 1475–81.

48.       Yildizhan, R., Kurdoglu, M., Adali, E., et al. “Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome.” Arch Gynecol Obstet 280.4 (2009): 559–63.

49.       Velija-Ašimi, Z. “Evaluation of the association of vitamin D deficiency with gonadotropins and sex hormone in obese and non-obese women with polycystic ovary syndrome.” Med Glas (Zenica) 11.1: (2014): 170–6.

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